Andrea F Dugas1, Alexandra Valsamakis2, Mihir R Atreya3, Komal Thind3, Peter Alarcon Manchego3, Annum Faisal3, Charlotte A Gaydos4, Richard E Rothman4. 1. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD. Electronic address: adugas1@jhmi.edu. 2. Department of Pathology, Johns Hopkins University, Baltimore, MD. 3. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD. 4. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, Division of Infectious Disease, Johns Hopkins University, Baltimore, MD.
Abstract
BACKGROUND: Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines. METHODS: A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was assessed by asking the clinician: "Do you think this patient has influenza?" Influenza-like illness was defined according to current CDC criteria. RESULTS: In this cohort of 270 subjects, 42 (16%; 95% confidence interval [CI], 11%-20%) had influenza. Clinician diagnosis had a sensitivity of 36% (95% CI, 22%-52%) and specificity of 78% (95% CI, 72%-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI, 14%-42%) and specificity of 97% (95% CI, 94%-99%); ILI had a sensitivity of 31% (95% CI, 18%-47%) and specificity of 88% (95% CI, 83%-92%). Only 15 influenza-positive patients (36%) received antiviral treatment. CONCLUSION: Clinician diagnosis, final ED EMR diagnosis, and ILI have low sensitivity for diagnosing influenza, and there is overall poor compliance with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting.
BACKGROUND: Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines. METHODS: A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was assessed by asking the clinician: "Do you think this patient has influenza?" Influenza-like illness was defined according to current CDC criteria. RESULTS: In this cohort of 270 subjects, 42 (16%; 95% confidence interval [CI], 11%-20%) had influenza. Clinician diagnosis had a sensitivity of 36% (95% CI, 22%-52%) and specificity of 78% (95% CI, 72%-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI, 14%-42%) and specificity of 97% (95% CI, 94%-99%); ILI had a sensitivity of 31% (95% CI, 18%-47%) and specificity of 88% (95% CI, 83%-92%). Only 15 influenza-positive patients (36%) received antiviral treatment. CONCLUSION: Clinician diagnosis, final ED EMR diagnosis, and ILI have low sensitivity for diagnosing influenza, and there is overall poor compliance with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting.
Authors: F G Hayden; A D Osterhaus; J J Treanor; D M Fleming; F Y Aoki; K G Nicholson; A M Bohnen; H M Hirst; O Keene; K Wightman Journal: N Engl J Med Date: 1997-09-25 Impact factor: 91.245
Authors: A S Monto; D M Fleming; D Henry; R de Groot; M Makela; T Klein; M Elliott; O N Keene; C Y Man Journal: J Infect Dis Date: 1999-08 Impact factor: 5.226
Authors: K G Nicholson; F Y Aoki; A D Osterhaus; S Trottier; O Carewicz; C H Mercier; A Rode; N Kinnersley; P Ward Journal: Lancet Date: 2000-05-27 Impact factor: 79.321
Authors: William W Thompson; David K Shay; Eric Weintraub; Lynnette Brammer; Carolyn B Bridges; Nancy J Cox; Keiji Fukuda Journal: JAMA Date: 2004-09-15 Impact factor: 56.272
Authors: Adrian K Ong; Mark I Chen; Li Lin; Adriana S Tan; Ni Win Nwe; Timothy Barkham; Seow Yian Tay; Yee Sin Leo Journal: PLoS One Date: 2009-12-29 Impact factor: 3.240
Authors: Ikwo K Oboho; Anna Bramley; Lyn Finelli; Alicia Fry; Krow Ampofo; Sandra R Arnold; Wesley H Self; Derek J Williams; D Mark Courtney; Yuwei Zhu; Evan J Anderson; Carlos G Grijalva; Jonathan A McCullers; Richard G Wunderink; Andrew T Pavia; Kathryn M Edwards; Seema Jain Journal: Open Forum Infect Dis Date: 2016-12-27 Impact factor: 3.835
Authors: Jessica Heimonen; Denise J McCulloch; Jessica O'Hanlon; Ashley E Kim; Anne Emanuels; Naomi Wilcox; Elisabeth Brandstetter; Mark Stewart; David McCune; Scott Fry; Sean Parsons; James P Hughes; Michael L Jackson; Timothy M Uyeki; Michael Boeckh; Lea M Starita; Trevor Bedford; Janet A Englund; Helen Y Chu Journal: Influenza Other Respir Viruses Date: 2021-05-03 Impact factor: 4.380
Authors: Nelson Lee; Edward E Walsh; Ian Sander; Robert Stolper; Jessica Zakar; Veronique Wyffels; David Myers; Roman Fleischhackl Journal: J Infect Dis Date: 2019-08-09 Impact factor: 5.226